Журнал "Гастроэнтерология" Том 54, №4, 2020
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The hormone-like cytokines usage for liver fibrosis diagnostic in patients with non-alcoholic steatohepatitis
Авторы: K.A. Lapshyna, O.Ya. Babak
Kharkiv National Medical University, Department of Internal Medicine № 1, Kharkiv, Ukraine
Рубрики: Гастроэнтерология
Разделы: Медицинские форумы
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Background. The hormone-like cytokines are considered crucial players in inflammatory-associated disorders. Non-alcoholic fatty liver disease (NAFLD) is characterized by excess lipid accumulation and in a substantial subset of patients with inflammation in the liver — non-alcoholic steatohepatitis (NASH) development. Such cytokines play a central role in many stages of liver diseases mediating fundamental aspects of those diseases like lipid metabolism, cholestasis, fibrosis and, also, regulate crucially the development of insulin resistance. Non-invasive measurement of hormone-like cytokines could be used for screening of individuals with high metabolic risk, identify patients with a poor prognosis, assess the progression of the disease, predict the response to therapeutic treatment. Achieving these goals will reduce the need to perform a liver biopsy.
The purpose was to evaluate the association of serum fibroblast growth factor 21 (FGF21) with liver fibrosis stage and metabolic markers in NASH patients.
Materials and methods. Fasting serum FGF21 was measured in 60 NASH patients (mean age 50.1 ± 6.9 years; 56.6 women). In addition to basic laboratory tests and ultrasonographic examination, the Fibromax test (Biopredective, France) were performed.
Results. Patients with NASH have higher serum FGF21 than those without (309.4 (279.4; 425.6) pg/ml Vs 99.5 (88.2; 117.5) pg/ml (p < 0.001). FGF21 correlated positively with BMI — direct link — r = 0.31 (p < 0.001), total cholesterol r = 0.41 with triglycerides r = 0.36 (p < 0.001); indicators of carbohydrate metabolism: with glucose — r = 0.48, r = 0.41 with insulin and r = 0.42 with a HOMA index (p < 0.001) regardless of patient gender. In logistic regression analysis, circulating FGF21 was found to be an independent predictor for subclinical atherosclerosis (P = 0.022) in addition to dyslipidemia and hypertension. The FGF-21 level in patients with stage F0 was 274.2 (269.8; 317.4) pg/ml, F1 — 347.7 (295.0; 416.8) pg/ml and F2–3 — 387.4 (303.0; 458.2) pg/ml (p < 0.05) according to the stages of liver fibrosis according to the Fibromax test.
Conclusions. Serum FGF21 levels correlated with markers of lipid and carbohydrate metabolism and predict subclinical atherosclerosis. FGF21 levels increase with liver fibrosis stage in NASH patients, and could be used as predictor marker of NASH progression.